| Summary: | Background: Research suggests that treatment of malaria is not evidenced based resulting in
malaria parasites becoming resistant to antimalarial drugs. WHO recommends a malaria rapid
diagnostic test (mRDT) for implementing the policy of test-based management of malaria to
avoid inaccurate diagnosis and misuse of antimalarial drugs. Ghana adopted the “Test-Before
Treat” guideline to facilitate the diagnosis for malaria with mRDT. However, Health Workers
(HWs) still treat half of febrile patients with negative malaria results with antimalarial drugs
suggesting limited or lack of acceptability of the intervention. This study sought to measure
the level of mRDT acceptability and examine its associated determinants among HWs in the
Kintampo North Municipality (KNM) of Ghana.
Methods: This study employed a cross-sectional study design from February to April, 2017.
Data on mRDT acceptability, its determinants and user characteristics were collected from
110 HWs in KNM involved in malaria management. The survey tool was based on two
frameworks – the Technology Acceptance Model (TAM) and Normalization Process Theory
(NPT). The latter proposed coherence, collective action, cognitive participation and reflexive
monitoring as determinants for the implementation of the health intervention. A composite
acceptability score was computed from a 21-item questionnaire for each respondent.
Composite scores were also computed for the key determinants as well as median and inter
quartile ranges. The respondents were divided into three equal groups (tertiles) for ordered
logistic regression to examine the relationship between acceptability and its determinants.
Results: The median acceptability score was 84 with interquartile range of 68-103. About
34% of HWs were in the low acceptability tertile, while 37% and 29% were in the moderate
and high acceptability tertiles respectively. In the unadjusted model, determinants relating to
each of the constructs of the adapted conceptual framework were identified, with a the clarity
ii
over the scope and boundaries of mRDT (coherence); variable investment in mRDT
(cognitive participation); availability of resources, skills and training to deliver mRDT
(collective action), improved reflection and feedback on the HW role in mRDT
implementation and its impact (reflexive monitoring), rural HWs and HWs with three and
above years’ experience positively influenced acceptability of mRDT. In the adjusted model,
improved coherence, cognitive participation, working in rural facilities, community health
officers and HWs with three and above years of experience were associated with high
acceptability of mRDT. Whilst improved reflexive monitoring negatively influenced
acceptability of mRDT.
Conclusion: To successfully implement mRDT for test based management of malaria, HWs
need to be equipped, resourced individually as well as the social or organizational context
within which they work. In addition, programme implementers and policy makers must
consider the roles of HWs and the how mRDT fit with their existing skill-sets. Furthermore,
supervision and technical support of HWs is essential to facilitate transition to test based
management with mRDT. === GR2018
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